Introduction
Addiction/substance use disorder continues to be a prevalent problem within the African American communities in the United States. The most common drugs used in this population, especially those living in urban settings, include marijuana, psychotherapeutic drugs, and crack cocaine. Research reveals that the use of drugs and alcohol consumption has resulted in increased rates of drug-related health problems among this population. Examples of these consequences include negative social impacts, increased alcohol-related injuries, and accidents, legal consequences, exposure to violence, exposure to communicable diseases such as HIV/AIDS, alcohol-related illness such as pancreatitis, oesophageal cancer, heart disease, and liver diseases, and even death due to drug overdose (Abadinsky, 2013). The purpose of this research is to examine addiction/substance use disorder treatment and recovery in urban settings, with a particular focus on African American communities. The research would help to enhance understanding of the extent and nature of drug use among the African America population, the barriers to treatment, and the best practices that can be implemented to treat addiction/substance use, and the advocacy strategies that social workers can do to advocate for best practices in the treatment of addiction/substance use disorders in urban, African American communities.
Although African Americans make up 14.2% of the total American population, the effect of addiction/substance use disorder on this community is startling. They make up 12.5% of illegal drug use. Statistics reveal that 2.2 million people within the African American population above 18 years of age have substance use disorder. Approximately 4.8 million people have a mental illness, and 1.1 million people have a co-occurring disorder of mental illness and substance use disorder (Ginwright, 2010). However, some studies indicate that addiction/substance drug disorder is not generally more significant among the African American populations, even those living in urban areas. Some researchers believe that the overrepresentation of African Americans in public drug treatment programs and criminal justice statistics have been facilitated by administrative practices and racial profiling of this population. Evidence shows that the misuse of substances among African Americans is the same rate as individuals in other races. Still, there is a variable rate of consequences such as drug arrests, criminal justice, addictions, and child welfare systems.
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It is evident that the culturally specific needs of African American population are not met. They are susceptible to continuous relapse and rotating door syndrome. Little research has been conducted on an exclusive focus on prevention and treatment among African Americans. Therefore, more research is needed to examine the extent of drug use, factors hindering access to treatment, identification, and implementation of best treatment practices, and determine appropriate advocacy strategies in promoting best recovery outcomes in the African American population.
Barriers to Treatment
Some factors hinder African Americans from seeking or accessing treatment and care for addiction/substance use disorder. Lack of resources to enter treatment is a barrier to treatment. Findings reveal that many of the crack abusers among African Americans are older and unemployed, do not have health insurance, are vulnerable to drug-related health risks, and are likely to reside in social environments with prevalence cocaine usage. Before the Affordable Care Act was implemented, an estimate of 20% of African American population was insured. However, recent studies reveal an improvement in coverage equality among minority groups. Although insurance helps cover some treatment costs, various facilities will work with patients to establish payment plans or find alternative approaches to assist the patient in achieving recovery goals. In addition, lack of adequate research on African-Americans who abuse is a barrier to treatment due to a lack of sufficient information that offers insights on how to address the problem (Sabri et al., 2013).
Sabri et al. (2013) state that the combination of mental illness and substance abuse poses challenges to treatment. Evidence reveals that severe mental health disorders such as co-occurring disorders, suicidal thoughts, and depressive episodes are rising among African American population. Substance use increases the symptoms of mental illness, which makes it more challenging for health care practitioners to diagnose severe psychiatric conditions such as schizophrenia, bipolar disorder, anxiety, and depression. A combination of substance abuse and mental illness is a condition referred to as a co-occurring disorder, which can be addressed by using an integrated treatment program, which combines intensive mental health treatment with substance use recovery.
The history of overrepresentation of African Americans in criminal consequences has resulted in various cultural sensitivities and fears surrounding substance use disorders. African Americans are more susceptible to mistrust government programs that are focused on treating substance use due to the social stigma or fears attached to it. Other factors that hinder African Americans from seeking quality treatment include untreated mental health disorders, limited access to transportation, lack of health insurance, and issues of poverty (Zapolski et al., 2014).
The individual-level barriers to seeking treatment, such as treatment readiness and motivation, could be facilitated by a lack of desire for help or lack of problem recognition. Evidence points out that problem identification is a significant step in seeking treatment. Minimal studies have investigated the motivation among African Americans who are substance users and its association with treatment entry. Research findings reveal that readiness to treatment is related to problem recognition. Therefore, self-recognition that substance use is a problem is an essential first step in the initiation process of treatment.
Although an individual may want to seek treatment, there are different external factors that come to play, such as structural barriers. The structural barrier to pursuing treatment include gender bias, day-care, cultural competency, transportation, and costs. In addition, the structural barriers prevent treatment programs from attaining and retaining the African American population in their programs. The demands of drug treatment programs are not based on the cultural dimensions of this population. The African Americans may find the programs to be culturally insensitive, for instance, by asking them to trust and open up to a stranger about the problems they are experiencing. Some may find this culturally inappropriate thus exit the program before receiving the help they need (Zapolski et al., 2014).
In addition, since drug abuse was treated as a crime in the past, many African Americans shy away from seeking treatment due to fear of incarceration. African Americans have experienced a disproportionate amount of incarcerations and legal and criminal issues because of drug use, possession, or selling. These aspects hinder individuals from seeking treatments. Moreover, evidence reveals that the African Americans with private insurance or means to access treatment do not get addiction treatment after seeking help in healthcare facilities. Evidence points out that racial inequality is the barrier to treatment and not the means. However, over the years, the increased addiction crisis in America became a public health issue nationwide, which changed the narrative across the country.
For many years, drug use and abuse were considered a criminal offense due to the efforts put in place to fight the sale and use of drugs. In the 1980s, the African Americans affected by addiction faced mass incarceration because of the drug war efforts implemented by the criminal justice to fight the 1980s crack and cocaine epidemics. The epidemic occurred in the African American community and became widespread in the white urban and suburban communities. This changed the narrative from criminal offense to addiction, identified as a disease and public health issue. The media, government, and communities pushed for an understanding that addiction is a disease, and we should be empathetic for those suffering from addiction. Talks on incarceration became less, and people heard more of the need to access treatment. However, African Americans are still facing incarceration than whites in similar scenarios. The approach to addiction impacts African Americans in a different, damaging, and negative manner compared to whites suffering from addiction (Alexander, 2020). Therefore, it is evident that the approach to addiction to substance use disorder in America is done differently depending on race.
Best Practices
Research reveals that there are lower rates of recovery from drug addiction among African Americans following treatment. To effectively address the treatment needs of African Americans, there are different cultural and social factors that should be put into consideration. These factors include having a multicultural staff, which is considered to be the most effective in delivering addiction treatment. In addition, programs for treating African Americans are beneficial because they allow them to represent their own race on the treatment team. Cultural differences between program providers and participants may demoralize the response to treatment. The programs should be located in areas where they are easily accessible to participants. Study findings show that lack of transportation is a significant barrier to treatment for the African American population. Another factor is spirituality and religion, which are major sources of strength among this population. It is important to recognize that spirituality is a prospective coping mechanism for treatment among African Americans. Study findings have revealed that spirituality among African Americans has contributed towards achieving more positive outcomes in the recovery process from substance use disorder (Staff, 2013).
According to Huang et al., (2020), the best practices for treating substance use disorder among African American populations can be achieved through healthcare providers conducting an initial assessment to identify the extent of addiction to help with the diagnosis and treatment. In addition, clinicians should offer clients opportunities to recognize and express feelings of their self-perception and their heritage. Moreover, clinicians should encourage clients to examine their strengths in their cultural heritages, histories, and backgrounds, such as opportunities to discover old and new ways to integrate spirituality into their lives. Moreover, clinicians should establish opportunities to create relationships and alliances with clients from other cultures and groups, such as the African Americans.
Ginwright (2010) points out that the development of effective programs will go a long way towards promoting addiction recovery among African American population. For instance, it is important to establish a program philosophy that supports personal growth within a cultural context. In addition, it is important for the programs to establish a connection with other community resources and management to assist with medical care, legal issues, and other support systems to addiction recovery. Furthermore, the programs should adopt acculturation examination tools, which should include information on acculturation level, stress, and experiences. The programs should also integrate psychoeducational family courses in their implementation for recovery addiction. Furthermore, the programs should focus on investing in staff training that is culturally competent.
The culturally competent training should enhance understanding of the common African America worldview, cultural beliefs, religion, spirituality, and customs, provide effective care and approach towards this population, and meet their treatment needs. In addition, this training will enhance understanding of the acculturative stress on African Americans. Louie et al. (2020) suggest that the onset of drug abuse among some African Americans is facilitated by acculturative and environmental stress, which leads to increased exposure to substance use. There is a positive correlation between acculturation and higher abuse rates, increased frequency, and quantities of substance use among the African American population. These correlations are very important in understanding and undertaking the delivery of effective substance abuse treatment. It is important to employ the role of acculturation as an integral theme in treatment planning.
The study by Wechsberg et al., (2020) suggests that pretreatment strategies and interventions could be effective in promoting treatment entry and enhancing treatment retention for drug addicts. The study findings have indicated that there is a need for research to be conducted to determine strategies that are more effective. Previous studies indicated that there is a need for appropriate consideration and cultural congruence for the treatment readiness of the African American population. The aspects of treatment readiness that can be determined include the self-efficacy and confidence of an individual to seek treatment and achieve recovery. Developing a culturally congruent pretreatment intervention helps to promote treatment readiness and motivation and reduce substance use. The pretreatment intervention is focused on providing African Americans substance abusers with personalized care regarding substance use and related problems, skills to improve individual responsibility to decrease substance use, and information regarding the treatment process. In addition, the intervention aims to offer assistance in establishing suitable social support systems in a setting where they feel accepted and safe. There is a likelihood that African Americans substance users could have different preexisting conditions, which could affect their motivation and readiness for treatment. Therefore, in this context, pretreatment intervention aims to establish a supportive environment for the participants in the African American population. In addition, the intervention helps to comprehend the concepts of recovery and the education regarding the process of becoming a participant in substance abuse treatment.
The pretreatment intervention paradigm supports the treatment of substance abuse from a four-phase approach. These include the client's knowledge of a problem, their comprehension of how to address a problem, an open attitude towards change on their part, and action or behavior that exhibits a positive process. Substance abuse is a rampant problem in poor communities. The pretreatment strategies can provide policymakers options to initiate treatment and decrease substance use among African American populations. Through identification of the crucial elements of pretreatment intervention could serve as a significant step towards having insights on the feasibility of this strategy to minimize barriers to treatment and increase access to treatment.
Advocacy
The study findings indicate that African American population is experiencing rampant addiction/substance use disorder. The commonly used substances include crack cocaine, psychotherapeutic drugs, and marijuana, which have negative impacts on the life of individuals, including health impacts, social impacts, and legal impacts, among others. There are various existing barriers that impede African Americans from seeking and accessing quality care to treat addictions/substance use disorder. Examples of these barriers include lack of individual treatment readiness and motivation, lack of resources to enter treatment such as limited access to transportation, lack of health insurance, and issues of poverty, and external barriers such as drug-user lifestyle, economic liabilities, and the extent of drug use. The aspects of a "healing community" that can promote addiction/substance use disorder recovery for African Americans who live in urban settings include developing culturally sensitive programs, pretreatment strategies, and interventions, and integrating cultural and social factors into treatment, such as having a multicultural staff to represent the African Americans in the treatment team. It is clear that the African Americans' cultural specific needs are not met in the addiction/substance use disorder treatment, making them vulnerable to continuous relapse and prevalence use of substances (Louie et al., 2020).
Social workers play an important role in advocating for best practices in the treatment of addiction/substance use disorders in urban, African American communities. Social workers can foster the development of an environment that is supportive of cultural sensitivity. This is one of the major aspects of engaging African Americans in treatment and assisting them in overcoming barriers to recovery. Evidence reveals that health care that is culturally responsive improved both long-term and short outcomes.
In addition, social workers should advocate for personalized care among the African American population. The study by Abuse, US & Office of the Surgeon General, US (2016) suggests that it is important for addiction treatment clinicians to treat each individual, which is crucial in providing the most effective substance abuse treatment among African Americans. Individualized care helps healthcare professionals consider all the variables, which impact a patient's mental health.
Examples of these variables include ethnicity, race, spirituality, and culture. Regardless of a person's background, an individualized treatment approach could result in improved recovery outcomes. An individualized approach is beneficial because it allows a healthcare provider to explore the complete picture of a person, which goes beyond many factors such as race and requires cultural sensitivity towards an individual's unique origins and history.
Moreover, social workers can advocate for social work training in evidence-based practices in this field. According to Louie et al., (2020), evidence-based approaches to addiction/substance use disorder helps to ensure the delivery of the most effective care to clients and achieve the best treatment outcomes. Scientific research is the most reliable source for identifying if an intervention is working. Due to this reason, evidence-based addiction treatment approaches are perceived broadly to be very effective for assisting substance use individuals overcome their drug addiction. The evidence-based approaches can be used with other research-based methods and therapies to promote achievement. The social work practice has a history of failing to train and prepare healthcare providers to work clinically with clients suffering from substance use disorder. Many of the social workers or clinicians are not adequately prepared to deal with addiction, which undermines the social work practice and their ability to promote positive recovery outcomes among clients with addiction/substance use problems. Training is important for facilitating the continuous growth of social workers' ability to implement and administer evidence-based treatments for substance use clients. With the changes in social policy and new evidence-based practices for addiction/substance use disorder, it is necessary for social workers to integrate these approaches in their practices to achieve positive outcomes.
According to Abuse, US, and Office of the Surgeon General (US. (2016), early interventions are necessary because it helps to prevent the risk of developing a substance use disorder. The use of drugs mainly emerges during adolescents and progresses into adulthood, resulting in the complexity and severity of its use. Early interventions help determine effective strategies to identify, treat, and manage substance use disorders and substance use problems. In addition, it is evident that early intervention provides a continuum of care such as supportive services, evidence-based medications, and a range of effective quality care. Evidence shows that the most effective way of helping an individual against substance misuse is through early screening. The barriers to the implementation of early intervention in addiction treatment of co-occurring substance use and mental disorders include workforce shortages, insufficient training, and lack of resources. Therefore, early intervention programs are designed to assist individuals in reducing or stop the negative impacts of substance use, manage the risk of relapse, and improve their social and health function. Substance use disorder helps to improve the productivity of an individual, their overall quality of life, and health.
References
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